Ectopic pregnancy risk when contraception fails. A review

Area of Science:

• Reproductive Health
• Clinical Pharmacology
• Obstetrics & Gynecology

Background:

• Ectopic pregnancies pose significant risks to maternal health.
• Understanding the failure rates and associated risks of various contraceptive methods is crucial for clinical practice.

Purpose of the Study:

• To alert healthcare providers to the elevated risk of ectopic pregnancy associated with specific contraceptive failures.
• To summarize data from U.S. Food and Drug Administration (FDA) reviewed trials on contraceptive efficacy and pregnancy outcomes.

Main Methods:

• Focused on 7 contraceptive drug products with known increased ectopic pregnancy risk upon failure.
• Extracted data from FDA clinical trial reviews and medical literature.
• Compared findings with 6 other contraceptive products and tubal ligation data.

Main Results:

• Pregnancies resulting from intrauterine devices, tubal ligations, progestin-only implants, and progestin-only oral contraceptives showed a range of 1:2 to 1:21 ectopic pregnancies.
• Postmarketing surveillance and published literature corroborate the proportions derived from clinical trial data, despite large confidence intervals in smaller trials.

Conclusions:

• Contraceptive methods including progestin-only oral contraceptives, progestin-only implants, intrauterine devices, and tubal ligations are associated with a higher likelihood of ectopic pregnancy if pregnancy occurs.
• Clinicians should be aware of this increased risk when counseling patients on contraceptive choices and managing unintended pregnancies.